Question Anesthesia and Pain Control

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Our anesthesiologists/CRNA's have recently started to work with an orthopedic surgeon who is doing total knee replacements( anesthesia code 01402) and requested that they perform adductor canal nerve blocks using ultrasound guidance for needle placement for post-op pain management( 64447-59). From what I have read. The time for the block must not be included in the time billed for the surgical general anesthesia and there must be separate documentation. We have done this, but are still getting denials from Medicare that indicate that payment was included in a previous payment. They are paying for the anesthesia just not the pain management. Also, they are using ultrasound guidance for needle placement. This is not bundled into code 64447 so am I able to bill this? From what I have read, Medicare will not pay, but some private payers will. I would appreciate any insight on the coding and I am going to post the same post in the billing section to see if they have any insight on the billing side of this. Thanks!


Sherman, TX
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It should be coded as follows for a patient with OA of the right knee that had a knee replacement with an adductor canal nerve block, single injection (it targets the femoral nerve):

27447/01402 M17.11
64447-59,RT, 76942-26 G89.18

The documentation for the nerve block should be on a separate form that indicates the block was performed at the request of the surgeon for the purpose of managing post-operative pain. There should also be a copy of the ultrasound picture.

If the documentation is compliant, appeal with all the notes. Nerve blocks are not inclusive to arthroplasties.